Navigating the landscape of healthcare programs can be complex, especially when it comes to understanding eligibility and enrollment. In Minnesota, healthcare coverage for eligible individuals and families is primarily managed through Minnesota Health Care Programs (MHCP). It’s crucial to understand that Minnesota Health Care Programs include Medicaid, along with other state and federal health care assistance programs. For healthcare providers looking to serve these populations, enrolling in MHCP is essential. This guide provides a comprehensive overview of the MHCP enrollment process, ensuring you have the information needed to become a participating provider and offer vital services to those relying on these programs.
Step-by-Step Guide to MHCP Provider Enrollment
Becoming an enrolled MHCP provider involves several key steps, designed to ensure the integrity and quality of care within Minnesota’s healthcare system. The Minnesota Department of Human Services (DHS) oversees MHCP, and the enrollment process is managed through the Minnesota Provider Screening and Enrollment (MPSE) portal. Here’s a detailed walkthrough of the enrollment procedure:
1. Initial Steps: Checking Excluded Provider Lists
Before initiating the MHCP enrollment process, it’s imperative to verify that neither you nor your organization, including employees and contractors, appear on any federal or state excluded provider lists.
The U.S. Department of Health & Human Services Office of Inspector General (OIG) maintains a List of Excluded Individuals and Entities (LEIE). This list includes individuals and entities barred from participating in Medicare, Medicaid, and other federal healthcare programs due to fraud, abuse, or other violations. MHCP adheres to these federal exclusions and also maintains its own state-level exclusion list.
Why is this crucial? MHCP is legally prohibited from enrolling or paying providers who are on these exclusion lists. Engaging with excluded individuals or entities can lead to significant penalties.
How to check the lists:
- OIG LEIE Search: Visit the OIG website and search the LEIE database by name.
- Frequency of Checks:
- Prior to initial enrollment
- Before hiring any new employees or contractors
- Monthly, to stay updated on any changes
Should an exclusion be discovered, it must be reported to MHCP Provider Eligibility and Compliance immediately via fax at 651-431-7462. Further information can be found on the Excluded Provider Lists page within the MHCP Provider Manual.
2. Meeting MHCP Requirements and Regulations
Eligibility for MHCP enrollment is contingent upon meeting specific requirements and certifications relevant to the healthcare services you intend to provide. These prerequisites ensure that all enrolled providers maintain a standard of competence and adhere to necessary regulations.
Determining specific requirements:
- Service-Specific Requirements: Consult the “Eligible Providers” section on the MHCP enrollment page (further down in this guide) to locate your provider type and associated licensure or certification needs.
- Provider Screening Requirements: Review the detailed Provider Screening Requirements page within the MHCP Provider Manual. This section outlines comprehensive screening procedures and criteria for various provider types.
Meeting these requirements is not just a formality; it’s a fundamental aspect of providing quality healthcare services within the MHCP network and upholding the standards expected by Minnesota Medicaid programs.
3. Obtaining Your Provider Identification Number (NPI/UMPI)
A crucial step in the enrollment process is securing the correct provider identification number. For most provider types, this is the National Provider Identifier (NPI). However, certain provider categories may utilize a Unique Minnesota Provider Identifier (UMPI).
National Provider Identifier (NPI):
The NPI is a unique, HIPAA-mandated identification number for healthcare providers. It is used for all administrative and financial transactions, including claims submission.
- NPI Requirement: Providers who are eligible for an NPI must obtain one before enrolling with MHCP.
- NPI Application: Apply for your NPI through the National Plan and Provider Enumeration System (NPPES) website: NPPES.
Unique Minnesota Provider Identifier (UMPI):
Specific provider types, primarily those not meeting the federal definition of a healthcare provider under HIPAA, may not be eligible for an NPI. In these instances, MHCP assigns a UMPI.
-
UMPI Eligibility: Provider types that may be assigned a UMPI by MHCP include:
- Home and community-based services providers
- Personal care provider organizations
- Day training and habilitation providers
- EIDBI Level II and III individuals
- Nonemergency medical transportation (NEMT) organizations
- Doula providers
-
UMPI Assignment: If you are in a UMPI-eligible category and do not have an NPI, you can still apply for MHCP enrollment. MHCP will assign you a 10-digit UMPI upon application processing and notify you via a Welcome letter.
Provider Types Not Typically Eligible for NPI (and UMPI Assigned by MHCP):
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (for MCO-only enrollment)
- Health care case coordinators
- Individual personal care assistants (PCAs)
- Community health workers
- Women, Infants and Children (WIC) programs
- Head Start programs
- Electronic Data Interchange (EDI) trading partners (for MCO-only enrollment)
- Non-emergency medical transportation (NEMT) drivers
Importance of NPI/UMPI: This number is mandatory for all fee-for-service claims submitted to MHCP. It ensures accurate billing and payment for services provided to Minnesota Medicaid members.
4. Submitting Your MHCP Enrollment Documents
With the prerequisites addressed, the next step is to formally submit your enrollment application to MHCP. There are two primary methods for submission:
Method 1: Online Enrollment via MPSE Portal (Recommended)
- MPSE Portal: The most efficient and recommended method is through the Minnesota Provider Screening and Enrollment (MPSE) portal: MPSE portal.
- Benefits of MPSE:
- Streamlined online application process
- Built-in guidance and error detection
- Real-time application status tracking
Method 2: Fax Submission
- Fax: Alternatively, you can complete the required paper documents and fax them to MHCP’s Provider Eligibility and Compliance division.
- Service-Specific Forms: To determine the necessary forms, refer to the “Eligible Providers” section and click on the link corresponding to your service type. These pages detail specific MHCP requirements and list the forms required for enrollment.
Important Note: MHCP does not accept enrollment documents via email. Submissions must be made through either the MPSE portal or by fax.
Application Fees for MHCP Enrollment
Certain MHCP provider types are required to pay a non-refundable application fee. This fee applies to new enrollments, re-enrollments, and revalidations.
Fee Requirement:
- Applicability: Check the Application Fees section of the Provider Screening Requirements page to determine if your provider type is subject to an application fee.
- Payment Timing: If a fee is required, it must be paid before submitting your enrollment application.
Electronic Funds Transfer (EFT) for MHCP Payments
MHCP strongly encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT), also known as direct deposit, for claim payments. This method offers significant advantages over traditional paper checks.
Benefits of EFT:
- Faster Payments: Access funds quicker without waiting for mail delivery or bank deposits.
- Enhanced Security: Eliminates risks associated with lost, stolen, or misdirected checks.
- Simplified Cash Flow Management: Reduces paperwork and streamlines financial processes.
EFT Enrollment Process:
- Minnesota Supplier Portal Registration:
- If you don’t have a Supplier ID, register as a “New Supplier” on the Minnesota Supplier Portal.
- Adding/Updating Banking Information:
- For existing Supplier IDs, update banking details via the Supplier Portal (refer to the Update Supplier Profile guide) or submit the MMB EFT Bank Change Request form.
- For questions about Supplier ID status, contact MMB at 651-201-8106.
- Activation Period: Allow 10 business days for your Supplier ID to become active after adding banking information.
- EFT Information Submission to MHCP:
- Enter your EFT Supplier ID and 3-digit location code in the MPSE portal (instructions in the MPSE user manual).
- Alternatively, fax a completed EFT Supplier ID Notification (DHS-3725) form to Provider Eligibility and Compliance at 651-431-7462.
Enrollment for Managed Care Organization (MCO) Providers
The 21st Century Cures Act mandates that state Medicaid agencies, including DHS in Minnesota, enroll all Medicaid providers, regardless of whether they participate in fee-for-service or Managed Care Organization (MCO) networks.
MCO Enrollment Requirement:
- Started July 17, 2023: Enrollment for MCO in-network only providers commenced on this date.
- Process: Follow the standard Enrollment Process outlined earlier in this guide.
- Additional Information: Refer to Enrollment process for MCO network providers for specific details.
Important Notes for MCO Providers:
- Existing Fee-for-Service Providers: If you are already enrolled as a fee-for-service provider and also contract with an MCO, you do not need to re-enroll.
- MCO Network Participation: Enrollment with MHCP for MCO providers is distinct from contracting with individual MCOs. To join an MCO network, you must also contact the relevant health plan directly. MCO contact information is available on the DHS website. See the MCOs page in the MHCP Provider Manual for further information.
- MCO In-Network Enrollment Instructions: Providers enrolling solely as MCO in-network providers should consult the MCO In-Network Provider Enrollment page in the MPSE User Manual.
MHCP Enrollment Approvals and Effective Dates
The effective date of your MHCP enrollment can vary depending on your location (Minnesota vs. out-of-state) and specific circumstances.
Providers Located in Minnesota
Minnesota-based providers may be eligible for retroactive enrollment. If all enrollment requirements are met, the effective date will be determined by one of the following:
- Provider-Requested Date: The date specified in your MPSE application or enrollment form.
- Application Month Start Date: The first day of the month in which MHCP receives your enrollment request.
- Medicare Certification Retroactivity: Up to 90 days prior to your Medicare certification effective date.
- Member Eligibility Date: The date the member you served was confirmed eligible for MHCP.
- Provider Compliance Date: The date you are confirmed to have met all MHCP provider requirements.
For providers requiring additional screening (site visits, background checks – typically moderate- to high-risk categories as detailed in the Risk Levels section), approval will occur upon completion of these screenings.
Providers Located Outside of Minnesota
Out-of-state providers can apply for MHCP enrollment specifically for dates of service provided to an MHCP member.
Requirements for Out-of-State Providers:
- State Licensing and Certification: Compliance with licensing and certification standards of your home state (except for home and community-based waiver services, which must meet Minnesota’s waiver plan requirements).
- Application Process: Submit an application via the MPSE portal with a copy of the Provider Agreement, assurance statements, and credentials, or fax documents to Provider Eligibility and Compliance.
Refer to Billing Policy Overview and Out-of-State Providers sections of the MHCP Provider Manual for further details.
Understanding Consolidated Providers in MHCP
A consolidated provider in MHCP is defined as a provider utilizing a single National Provider Identifier (NPI) across multiple enrollment records. This situation can arise when a provider offers diverse services or operates from multiple locations.
Consolidation Scenarios:
- Multiple Service Types: A provider offering various service types may require multiple enrollment records, as not all services can be billed under a single record.
- Multiple Locations: Providers with several locations may also have multiple enrollment records.
MHCP’s Approach to Consolidation:
Provider Eligibility and Compliance reviews providers with multiple active credentials across different enrollment records to determine if consolidation is necessary. MHCP often uses Provider Type (PT) 33 to consolidate records under a single NPI.
Taxonomy Codes and Consolidated Billing:
- Shared Physical Address/Zip Code: If multiple records under one NPI share a physical address or zip code, taxonomy codes are required for each record post-enrollment and MN–ITS registration. Custom taxonomy codes can be used if records are limited to and share the same code.
- Unique Physical Addresses: If records under one NPI have unique physical addresses, the service facility location must be submitted on claims.
- Taxonomy Code Submission: Submit taxonomy or custom taxonomy codes via MN–ITS. A tutorial is available: Adding Taxonomy Codes video.
MN–ITS Registration: Essential for MHCP Providers
MN–ITS (Minnesota–Information and Technology Services) is a free, web-based, HIPAA-compliant system that is mandatory for all MHCP providers.
MN–ITS Registration Process:
- Automatic for MPSE Enrollees: If you enroll via MPSE, MN–ITS registration information (initial User ID, Password) will be included in your Welcome letter upon enrollment approval.
- Manual Registration for Fax Enrollees: Providers enrolling via fax must register for MN–ITS separately using registration instructions.
Key Functions of MN–ITS:
MN–ITS is your primary interface with MHCP for a wide range of essential functions, including:
- Eligibility Verification: Confirm MHCP eligibility for members.
- Secure Communication: Retrieve enrollment-related letters and notices.
- Authorization Requests: Submit prior authorization requests for services and supplies.
- Service Agreements: Manage service agreement requests for home care.
- Document Retrieval: Access authorization and service agreement letters, and other documents in your MN–ITS mailbox.
- Claims Submission: Submit electronic claims (required by Minnesota law [https://www.revisor.mn.gov/statutes/cite/62J.536]), including those with third-party insurance or Medicare.
- Claim Management: Copy or replace incorrectly submitted claims.
- Claim Status Checks: Verify payment or denial status of claims.
- Remittance Advices (RAs): Access and download RAs via the MN–ITS Mailbox.
- MPSE Access: Link to the MPSE portal to manage your enrollment records.
MN–ITS is equally crucial for MCO In-Network Only Providers. Registration is required, and access allows management of enrollment information via the MPSE portal and retrieval of important notices.
Keeping Your MHCP Enrollment Information Updated
Maintaining accurate and current enrollment information is the provider’s responsibility. Changes must be reported to MHCP promptly.
Preferred Method: MPSE Portal Updates:
The most efficient way to update your enrollment record is through the MPSE portal. MPSE update request.
MPSE Training Webinars: MHCP offers quarterly webinars on using MPSE to manage enrollment changes. Register on the MPSE Training site.
Alternative: Faxing Change Forms:
Specific changes can also be reported by faxing relevant forms. Ensure you use the fax number listed on each form.
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535): For individual provider information changes or affiliation updates.
- Organization MHCP Provider Profile Change Form (DHS-3535A): For organization contact or enrollment information changes.
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259): For changes in management, board composition, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087): For adding/removing electronic RA or RA affiliations with billing organizations. (Not for MCO-only providers).
- EFT bank change form: For direct deposit information changes (submitted to Minnesota Management and Budget – MMB).
- EFT Supplier ID Notification (DHS-3725): For changes to your MMB-issued EFT Vendor Number or Location Code. (Not for MCO-only providers).
- Provider Entity Sale or Transfer Addendum (DHS-5550): For reporting ownership changes due to sale or transfer. Requires submission of new enrollment documents and may lead to payment reversals for terminated providers.
Provider Eligibility and Compliance will process change requests and contact you if further documentation is needed. Enrollment status letters are issued to confirm changes in provider participation.
MHCP Enrollment Processing Timelines
Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, regardless of submission method (MPSE or fax). This 30-day timeline applies to new, corrected, and resubmitted requests.
Complete vs. Incomplete Requests:
- Complete Request: All required fields are filled, and all necessary documents are submitted. MPSE users can track status in the Request Submitted and Next Steps section of the MPSE user manual.
- Incomplete Request: If information is missing, MHCP will issue a Request for More Information (RFMI) letter via MN–ITS mailbox or U.S. mail.
Responding to RFMI:
- Response Timeframe: You have 60 days to respond to the initial RFMI and provide the missing information.
- Submission Method Consistency: Reply using the same method as your original application (MPSE or fax).
- Second RFMI: If the initial response is still incomplete, a second RFMI will be issued, granting an additional 30 days to provide the remaining information.
- Denial for Continued Incompleteness: Failure to provide complete information within these timeframes will result in denial of your enrollment request.
Processing Time After Corrections: Allow up to 30 days for processing from the most recent date of submission of materials, including corrections.
Inactive Enrollment Records: If your enrollment record becomes inactive, re-enrollment with MHCP is required, using either the MPSE portal or faxing a new application.
Billing Organizations and MHCP
MHCP-enrolled providers have the option to utilize billing organizations, such as clearinghouses or billing intermediaries, to submit claims and transactions electronically.
Enrollment for Billing Organizations:
Clearinghouses and billing intermediaries submitting claims on behalf of enrolled providers must themselves enroll with MHCP as billing organizations. Billing organization enrollment information is available in the MHCP Provider Manual.
Who Can Enroll? MHCP Eligible Providers
Participation in Minnesota Health Care Programs requires meeting specific professional certification and licensure standards mandated by state and federal regulations. Once these professional prerequisites are met, providers can apply for MHCP enrollment via the MPSE portal or faxing required application materials.
MCO Network Enrollment: Contact your contracted Managed Care Organizations (MCOs) directly for their specific enrollment requirements, in addition to MHCP enrollment.
Provider Type List:
The following table outlines the various healthcare provider types eligible for MHCP enrollment. Note that:
- Providers marked with ¹ do not receive direct payment and must bill through an organization.
- Providers marked with ² are not eligible to enroll as MCO-only providers.
| ### Organization Providers | ### Individual Providers |
|---|---|
| Adult Day Treatment – 46 | Acupuncturist – AP |
| Allied Oral HealthProfessional Group – 31 | Alcohol and Drug Counselor – DC |
| Ambulatory Surgical Center – 22 | Allied Oral HealthProfessional– 31 |
| Birthing Center – B1 | Audiologist – 43 |
| Certified Registered Nurse Anesthetist Organization – 67 | Certified Mental Health Rehabilitation Professional¹- 26 |
| Child and Teen Checkup Clinic – 16 | Certified Nurse Midwife – 66 |
| Children’s Residential Treatment Facility¹- 06 | Certified Professional Midwife – C1 |
| Community First Services and Supports (CFSS) – CFSS | Certified Registered Nurse Anesthetist – 67 |
| Community Health Clinic – 58 | Chiropractor – 37 |
| Community Mental Health Center – 10 | Clinical Nurse Specialist – 68 |
| County Case Manager²- 23 | Community Health Worker¹ – 55 |
| County Human Services Agency² – 45 | Dentist – 30 |
| Day Training and Habilitation for ICF/DD– 19 | Direct Support Worker, Individual¹, ² – 38 |
| Dental Group – 30 | Doula – DA |
| Doula Entity – DA | Early Intensive Developmental and Behavioral Intervention² – EI |
| Durable Medical Equipment – 76 | Health Care Case Coordinator – 27 |
| Early Intensive Developmental and Behavioral Intervention² – EI | Hearing Aid Dispenser – 77 |
| Electronic Data Interchange (EDI) Trading Partner² – 28, 95, 98 | Home Care Nurse – 64 |
| Family Planning Agency – 54 | Licensed Independent Clinical Social Worker – 14 |
| Federally Qualified Health Center – 52 | Licensed Marriage and Family Therapist – 25 |
| Home and Community-Based Services (HCBS) – 18 | Licensed Professional Clinical Counselor- 63 |
| Moving Home Minnesota – 18 | Licensed Psychologist – 42 |
| Housing Stabilization Services – 18-HSS | Nurse Practitioner – 65 |
| Housing Support Supplemental Services – 18 | Occupational Therapist – 29 |
| Home Care Nursing Agency Group – 64 | Optometrist – 35 |
| Home Health – 60 | Pharmacist¹ – 70 |
| Hospice – 02 | Physical Therapist – 39 |
| Hospital – 01 | Physician – 20 |
| Independent Diagnostic Testing Facility – 32 | Physician Assistant – 69 |
| Independent Laboratory – 80 | Podiatrist – 36 |
| Independent X-ray – 81 | Registered Dietician or Licensed Nutritionist – 15 |
| Indian Health Services – 51 | Speech-Language Pathologist – 40 |
| Individualized Education Program – 09 | Transportation Driver¹ – DR |
| Institution for Mental Disease¹ – 03 | |
| Intensive Residential Treatment Services – 50 | |
| Intermediate Care Facilities – 05 | |
| Medical Services Group – 49 | |
| Medical Transportation – 82 | |
| Mental Health Group – 34 | |
| Non-Profit Dental Organization | |
| Nursing Facility – 00 | |
| Optical Company – 75 | |
| Personal Care Provider Organization² – 38 | |
| Pharmacy¹ – 70 | |
| Psychiatric Residential Treatment Facility – PR | |
| Physician Clinic – 20 | |
| Public Health Clinic – 57 | |
| Public Health Nursing Organization – 61 | |
| Recovery Community Organization – RC | |
| Recuperative Care Services – RE | |
| Regional Treatment Center – 17 | |
| Rehabilitation Agency – 11 | |
| Rehabilitation Group – 48 | |
| Renal Dialysis Center – 04 | |
| Rural Health Clinic – 53 | |
| Substance Use Disorder – 62 | |
| Targeted Case Management – 44 or 18 | |
| Transportation Coordinator² – 72 |
Enrolling in Minnesota Health Care Programs, which includes Medicaid, is a vital step for healthcare providers in Minnesota to ensure they can offer their services to a broad population in need. By meticulously following these steps and maintaining up-to-date enrollment information, providers contribute to a robust and accessible healthcare network within the state.
